The purpose of this dissertation was to explore the determinants of Pap screening completion among sub-Saharan African immigrant women. Cervical cancer is a public health problem globally. The risk of invasive cervical cancer remains high among sub- Saharan African immigrant women in the US despite being a preventable cancer. Early detection through Pap screening is crucial for prevention, treatment and prognosis. The specific aims of this dissertation were to 1) examine Pap screening practices among African immigrant women and to identify gaps to guide future research; 2) explore barriers and motivators that influence Pap screening decisions among African immigrant women; and 3) explore African immigrant men’s knowledge of Pap screening and attitudes about supporting their wives/female partners to utilize Pap screening, and 4) explore predictors of Pap screening use among sub-Saharan African immigrant women, Specific aim one was addressed by a review and synthesis of literature focused on Pap screening among African immigrant women. Common factors influencing Pap screening completion included immigration status, health care interactions, knowledge deficiency, religiosity, and certain personal characteristics. Specific aim two was addressed by the conduct of a qualitative descriptive study of barriers and motivators contributing to Pap screening decisions in 22 African immigrant women. Women experienced different barriers including low knowledge of screening, cultural beliefs, fear and communication issues. Addressing knowledge gaps and other barriers related to Pap screening may improve Pap screening participation in this group. Specific aim three was addressed by a qualitative descriptive study of men’s attitudes and beliefs regarding Pap screening and support for their wives for Pap screening participation. African immigrant men demonstrated suboptimal knowledge and awareness of cervical cancer screening. Most men had a lack of knowledge regarding HPV and its link with cervical cancer. Despite knowledge deficiency men showed significant interest in supporting their wife/female partners. Specific aim four was addressed by conducting an analysis of cross sectional data collected from 108 sub-Saharan African women. Predictors of Pap screening completion was determined using logistic regression while controlling for age and education. Pap screening awareness and provider’s recommendations were independent predictors of Pap screening. Given the unequitable burden of cervical cancer experienced by this population, the findings from this dissertation point to the need for a multilevel targeted health interventions directed toward African immigrant population are needed to increase the rates of Pap screening among African immigrant women. Prevention efforts should focus on individual level factors and develop culturally relevant strategies that will effectively provide educational outreach interventions and alleviate barriers to Pap screening. Engaging spousal support and addressing social norms related to spouses/partners’ roles that may influence partaking in cervical cancer screening is important among African immigrant women. Cervical cancer is preventable; Pap screening will lead to early detection of cervical cancer in female African immigrants.

Les immigrants à Montréal (Québec, Canada) connaissent des difficultés d’insertion en emploi. Parmi eux, ceux originaires de l’Afrique subsaharienne constituent des «groupes racisés» et, à ce titre, sont susceptibles d’éprouver davantage de discriminations et de difficultés que les autres (Hadiri, 2008; Nikuze, 2011). Grâce à une sociologie des "trajectoires de réussites" et grâce à des questions mobilisant l'apport de plusieurs disciplines dans une perspective de résolution de problèmes pratiques, cette thèse a pour but de proposer de possibles solutions aux différents problèmes de ces immigrants montréalais. La recherche de terrain, basée sur des entretiens compréhensifs au sens où l’entend Kaufmann (1996, 2008), propose une sociologie qualitative des "trajectoires de réussites", soit des expériences socioprofessionnelles vécues comme « valorisantes » ou « valorisées. » L’échantillon a été formé d’immigrants africains vivant de telles expériences. À travers leurs différentes trajectoires, la recherche a reposé sur cet objectif appliqué premier : partir du questionnement central sur les facteurs de réussite, rechercher des solutions et des instruments d'intervention destinés à une meilleure intégration socioéconomique des nouveaux immigrants, ou même des anciens immigrants qui connaissent encore des difficultés d’insertion en emploi. Les résultats laissent entrevoir trois catégories de facteurs contributifs à la base de la «réussite socioprofessionnelle», tous rangés au titre de « valeurs », ou façons de voir le monde capables de contribuer à cette « réussite » en s’harmonisant mieux au contexte québécois : il s’agit de valeurs personnelles, d’apports socioculturels africains ou encore de ressources socioculturelles de type québécois. Si les valeurs personnelles relèvent des caractéristiques propres à chacun, les ressources socioculturelles africaines et québécoises résulteraient plutôt de traditions ou de mœurs inhérentes aux cultures des pays concernés. L’analyse et l’interprétation de ces facteurs propices à l’intégration socioprofessionnelle des immigrants ont révélé plusieurs pistes capables de faciliter l’insertion en emploi des immigrants et cette thèse en fait état. Il demeure certain, face à des résultats qui mettent en évidence surtout le facteur individuel, que la « réussite » et l’insertion « réussie » ou vécue comme telle demeurent aussi fonction des actes des autorités publiques : quelles que soient les valeurs et les dispositions individuelles des immigrants, ces facteurs positifs demeurent sans effets si lois et politiques du domaine de l’immigration font obstacle de quelque façon. / Immigrants in Montreal, Quebec, Canada are experiencing job integration difficulties. Some racialized groups are experiencing even more problems, and specifically those from sub-Saharan Africa are considerate as "racialized groups" which opens the door to greater discrimination and other difficulties (Hadiri 2008; Nikuze, 2011). Drawing from a sociology of "success trajectories" through questions and mobilizing the contribution of several disciplines with a view to solving practical problems, I seek to propose possible solutions to various problems of these immigrants. Field research, based on comprehensive interviews of Kaufmann (1996, 2008), offers a qualitative sociology of "trajectory of success" or socio-professional experiences as "rewarding " or " enhanced." The sample was composed of African immigrants living through such experiences. Through their different paths, the research was based on this primary objective: begin with the central question of the success factors; search for solutions and policy instruments for better socio-economic integration of new immigrants; or even less-recent immigrants’ still experiencing difficulties integrating into employment. The results suggest three categories of contributing factors to the base of the "social and professional success," all arranged under "values," or ways of seeing the world can contribute to this "success" in better harmonizing the Quebec context. This includes personal values, African sociocultural contributions, and Quebec sociocultural resources. If personal values are drawn from an individual’s specific characteristics, African and Quebec sociocultural resources would result from inherent traditions or customs of the cultures of the countries concerned. The analysis and interpretation of these factors conducive to the socio-professional integration of immigrants revealed several tracks that can facilitate employment integration of immigrants as this thesis reported. It remains certain in the face of results that highlight especially the individual factor, the "success" and inserting "successful" or experienced as such remain a function of the actions of public authorities: whatever the values and provisions of individual immigrants, these positive factors remain without effect if laws and policies in the field of immigration impede in any way.